MEDICARE: RENEE C. KORONKOWSKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	45564	MN

General Provider Information

NPI Number	:	1477522027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE C. KORONKOWSKI MD

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:	MR 10809
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55440-0043
Country	:	US
Telephone Number	:	612-262-4813
Fax Number	:	612-262-4194

Provider Business Practice Location Address
First Line	:	550 OSBORNE RD NE
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-3804
Fax Number	:	763-236-3821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	03/11/2021

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